Skip to main content

Moving in the Wrong Direction

It's been in the news recently, the upcoming 5 version to the Diagnostic and Statistical Manual for Mental Disorders - or DSM 5.  The DSM, published by the American Psychiatric Association, is the guidebook that every mental health professional is supposed to use to make a mental health diagnosis.  It contains the symptoms, timeframes, and exclusions for every condition from acute stress disorder to voyeurism.

Where the magic happens.
Version 5 has been worked on for years and is due out in 2013.  Much of the news reports about this version have to do with the elimination of Asperger's in lieu of creating an Autism spectrum on which people with Asperger's will now fall on the mild end.  Other concerns are that normal bereavement will now be considered major depression due to loosening of the depression diagnostic criteria.  But my concern lies with the changes to an existing diagnostic category - Somatoform Disorders.

Rather than repeating what's in store in DSM 5, this article provides an excellent summary of the proposed changes.  It's really worth taking the time to read, whether you have diabetes, irritable bowel syndrome, lupus, or fibromyalgia.  The bottom line is, regardless of the etiology of your chronic illness you are a candidate for the Somatic Symptom Disorder (SDD) diagnosis.  If you're a parent caregiver, your reactions to your child's illness may be deemed pathological as well.

So what does this mean?

Like most things in the DSM, there's ambiguity and room for interpretation from the mental health provider about if a symptom or behavior meets the diagnosis criteria.  Terms like "excessive," "disproportionate," and "exceedingly high" are used to describe worry or time/attention dedicated to one's health.  My opinion on what's excessive health-related worry may differ from the next therapist and from the next.  What happens when people living with chronic illness are experiencing relatively normal reactions to a flare up or new diagnosis and are labeled with SDD?  So now they not only have Rheumatoid Arthritis but have RA and SDD.

Will their symptoms be taken as seriously or will they be seen as people who blow things out of proportion and be blown off?

Actual someecard.
Will a diagnosis of SDD be given in haste to a person with as-yet medically unexplained symptoms, who will then be denied testing to ensure there really isn't something wrong?

Will the SDD diagnosis become the diagnosis du jour for women experiencing physical complaints?  Notice the task force for SDD is a bunch of men.  The only woman on the panel "was withdrawn" in 2011.

You demand answers?  You must be excessively anxious.
Are there people who have "excessive" or "disproportionate" concerns about their health or medical diagnosis?  Yes.  I think of people who cut themselves off from their friends and family, who can't go to work for fear of having symptoms in public, or who cannot think of much else other than their illness.  In my experience, this is not the norm but a relatively small percentage of the hundreds of people I've seen living with a chronic medical condition.  And I'm not sure what giving them an SDD diagnosis will do for them, even if they met the "official criteria."

The most concerning thing is there is no published research to back up any of this.

Yeah!
As someone who has spent the last 9 years trying to advance the understanding and integration of physical and mental health, and de-stigmatize normal human reactions to illness, especially for those with "functional" conditions like Irritable Bowel Syndrome, I see this reclassification as an enormous step in the wrong direction.  Rather than acknowledging that with a chronic illness comes normal feelings of worry, sadness, frustration, curiosity, anger, or *gasp* anxiety or depression, the DSM 5 is pathologizing them.  And only one of these "excessive" feelings need be present, only for 6 months.

Are the members of the committee responsible for this change really trying to say that someone who was diagnosed with stage 3 breast cancer a month ago best get their emotions under control because the statute of limitations on worry is 182 days?

Clock's tickin' people.
Or the person living with severe Irritable Bowel Syndrome, a still relatively poorly-understood condition with few medical treatment options, shouldn't spend more than an hour or 2 on the internet looking for remedies or connecting with others via online support communities?  People living with IBS already face considerable stigma and implication that their symptoms are "all in their head."  Consider what an additional diagnosis of SDD would do to their status in both the medical and lay community.

Or the mother of a child with multiple, severe food allergies who is worried about contamination and its subsequent anaphylaxis?  Is her vigilance in keeping her child safe from a potentially lethal event "excessive" or the normal reaction to something that could prematurely end her child's life?  Is it something I should recommend some Valium for or validate as normal and help her cope with?

What are your thoughts on these changes?  Will SDD be a help or hindrance to those living with a chronic medical condition?

Popular posts from this blog

IBD & Medical Trauma

Medical trauma is such an under-recognized issue for the chronnically ill. It's a hard topic to talk about because it can seem like we are pointing fingers at healthcare workers. Maybe that's why there are only, now, 4 studies on the topic in patients with inflammatory bowel disease (IBD). If you are someone who treats people with IBD please know I am not here to demonize or criticize. I am both a patient and a GI psychologist. I know the medical system from both sides. I know how messed up and broken it is. But ignoring this or rationalizing it away as only affecting a few folks is wrong. So let's talk about it. Post-traumatic stress (PTS) is the term we use for medical trauma due to technicalities in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for post-traumatic stress disorder (PTSD). PTS can be less severe that full on PTSD, or it can be full on PTSD. Regardless, the symptoms are identical: Feeling hypervigilant/on-edge (increased

Primal

Greetings!  It's been a while. I'll blame COVID brain on my lack of writing over the past year. Can you believe it's been a year of this shit? And it looks like we're about to ride another wave, this time the variants B117 and P4.  I'm not here to write about COVID. I'm here to talk about food. Specifically, the psychology of eating. There's a lot of attention being given to this idea of "ARFID" or Avoidant Restrictive Food Intake Disorder, in patients with chronic digestive disease. This is a psychiatric diagnosis conceptualized mostly for children with sensory issues or similar concerns. The main questionnaire used to assess ARFID, the Nine Item ARFID Scale (NIAS), is only validated in children .  While I absolutely agree there are adults with chronic digestive disease who meet the criteria for ARFID, this whole thing makes me a bit twitchy. Here's why. First: Did you ever drink too much tequila and puke and maybe have one of the worst hango

Stress: What it Does to Your Body

As we continue to explore anxiety and the impact stress, I thought this would be an ideal time to discuss some of the physical symptoms that stress can have on your body. Simply put: stress leads to distress – so much so that 77% of Americans experience physical symptoms caused by stress. Distress of your body manifests itself in various ways for each person. For some, it can resemble a headache or migraine, it can upset your digestive tract, increase your blood pressure, reduce sleep and even cause chest pain. Some research has suggested when your body is in distress , it may exacerbate (bring on or worsen) certain illnesses and diseases. Additionally, when people try and use tobacco, alcohol or other drugs (including prescriptions) to relieve stress, the long-term effect may be more harmful than helpful for your body.   Looking at some basic statistics, 44% of Americans have reported feeling more stressed than they did five years ago; three out of four doctor visits are for st